Provider First Line Business Practice Location Address:
172 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-6523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-294-8442
Provider Business Practice Location Address Fax Number:
845-258-4611
Provider Enumeration Date:
01/26/2006